As I noted earlier, the real surprise in the House health care bill wasn’t the public plan–we had pretty much known for days that House Speaker Nancy Pelosi didn’t have the votes to pass her preferred version, the so-called “robust” public plan, which would have closely tied its reimbursements to health care providers to Medicare’s rates (which can run 30% lower than what private insurance pays them). So she had to settle for one that would operate in many ways like an insurance company, negotiating with hospitals and doctors and other health care providers, and paying them significantly more generous reimbursements.

It was that decision, I am told, that led to the real news in the bill–a provision, inserted at the last minute, to drastically expand the Medicaid program, even beyond what had been anticipated in an earlier version of the legislation. Here’s what happened: